Open Access Journal of Contraception
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Knowledge and attitudes about emergency contraception among pharmacist and physician preceptors in South Carolina This article was published in the following Dove Press journal: Open Access Journal of Contraception 24 August 2010 Number of times this article has been viewed
Sarah Shrader 1,2 Ann M Rodden 1 Lisa Carroll 3 Lars E Peterson 1 1 Medical University of South Carolina, Department of Family Medicine, Charleston, SC, USA; 2 South Carolina College of Pharmacy, Department of Clinical Pharmacy and Outcomes Sciences, Charleston, SC, USA; 3Spartanburg Regional Family Medicine Residency Program, Department of Family Medicine, Spartanburg, SC, USA
Background: Emergency contraception (EC) may reduce unintended pregnancies if patients are informed and have access. A great deal of medical education occurs during medical and pharmacy training community clerkships. This study concurrently assesses knowledge and attitudes about EC between community physician and pharmacist preceptors who prescribe/ dispense EC. Study design: Electronic survey of demographic information, knowledge-based, and attitude questions related to EC was completed by 182 (36.6% response rate) South Carolina community physicians and pharmacists who precept students. Comparisons were performed using chi-square or Fischer’s exact test. Results: In the study population, approximately 62% of pharmacists dispense EC while only 28% of physicians prescribe it. More physicians than pharmacists believe repetitive use is not harmful (48.3% vs 28.0%, P = 0.010), while more pharmacists believe it causes birth defects (22.6% vs 7.9%, P = 0.008). Conclusion: Overall, both physicians and pharmacists have poor knowledge about EC. Further education for both groups may be needed so future physicians and pharmacists are not taught incorrectly during their training and so patient access is not hampered by prescriber misunderstanding. Keywords: emergency contraception, levonorgestrel, pharmacist, physician
Introduction
Correspondence: Sarah Shrader Medical University of South Carolina, Department of Family Medicine, 295 Calhoun St. FM322A, Charleston, SC 29425, USA Tel +1-843 792 3624 Fax +1-843 792 0436 Email
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Dovepress DOI: 10.2147/OAJC.S10714
Emergency contraception (EC) is an important and controversial issue in health care. EC to prevent pregnancy after intercourse has the potential to reduce unintended pregnancies in the United States (US). According to the latest national family planning statistics, from 2002, 35% of births in the US are unintended with rates much higher in women under 18 years of age and in all women with an education less than a high school diploma. The unintended pregnancy rates for those populations are approximately 60%.1 More specifically, South Carolina ranks as having the 18th highest teen pregnancy rate in the nation.2 In 2006, the Food and Drug Administration (FDA) approved nonprescription s tatus of the progestin-only EC containing levonorgestrel (LNG-EC), which allows any person, with valid identification, who is 18 years and older, to purchase nonprescription LNG-EC. Subsequently, in 2009, the FDA reduced the age for purchase of nonprescription status to any person 17 years of age and older. Women may prefer to have a prescription from a medical provider, but only those under 17 years of age are required to have a valid prescription for a pharmacist to dispense EC.
Open Access Journal of Contraception 2010:1 73–78 © 2010 Shrader et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
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Considering this shift to nonprescription status, both physicians and pharmacists may directly impact access to this form of EC. Responsibilities of these health care providers include providing prescriptions, dispensing the medication (prescription and nonprescription), providing patient education, and in some cases providing education about EC to medical and pharmacy students whom they precept. After LNG-EC was approved for nonprescription status, the manufacturer, many pharmacy organizations, and EC advocate groups provided major educational campaigns for pharmacists. Previous studies have examined attitudes and knowledge of physicians and pharmacists about EC.3–8 The majority of the results suggest there are myths surrounding EC. Knowledge of EC was generally average to poor and improvements in knowledge and attitudes for both pharmacists and physicians may be warranted. To date, no study has performed a concurrent assessment of knowledge and attitudes of community physicians (specifically family medicine physicians) and community/ outpatient pharmacists. In addition, community physicians and pharmacists who precept for medicine and pharmacy academic programs have the potential to influence student training and prescription/dispensing habits of these future physicians and pharmacists. The purpose of this study was to concurrently assess knowledge and attitudes about EC of both community physicians and community pharmacists practicing in South Carolina who are also preceptors for the Medical University of South Carolina (MUSC). The primary objective was to determine if there were knowledge gaps and misinformation within the groups. The secondary objective was to determine differences in these areas when comparing the two professional groups.
Methods Survey A survey about emergency contraception, specifically LNG-EC, was developed from a previous survey reported in the literature; modifications were implemented based on the primary study objective and updated information.7 The survey focused on basic demographics, prescribing/dispensing habits, knowledge-based questions, and attitude questions about EC. The correct answers to the knowledge questions were based on information from the American College of Obstetricians and Gynecologists practice bulletin on EC and from updated information released regarding mechanism of action.9,10 A small group of family physicians and community pharmacists piloted the survey and offered feedback, which provided the basis for revisions.
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Study design/objective Participants consisted of two distinct groups: (1) community pharmacists who precept in the College of Pharmacy Clerkship at the MUSC; and (2) family medicine physicians who precept in the MUSC Family Medicine Rural Clerkship or at family medicine residency programs throughout South Carolina. The family medicine residency programs included faculty and residents in the survey since both actively teach medical students during clerkships. The final survey was distributed to the study participants by means of an electronic survey system (Surveymonkey Software®, Portland, OR). Two reminders to complete the survey were sent over a two-month period (data collection January–February, 2009). Participants voluntarily and anonymously submitted the survey. At the completion of the study, the survey portal offered educational information about EC along with website links that the participant could access, if desired.
Statistical analysis Descriptive statistics were used for demographic data analysis. Comparisons were made with either the chi-square test or Fischer’s exact test when expected cell sizes were less than five. With a sample size of 93 pharmacists and 89 physicians, we had power equal to 0.80 to detect an effect size of 20 percent difference between groups. All statistical analyses were performed with SAS v9.2 (Cary, NC). This study was considered exempt and approved by the MUSC institutional review board.
Results Almost 500 community physicians and pharmacists in South Carolina were sent the survey and 182 completed it, representing a response rate of 36.6% (Table 1). Most physician responders had practiced fewer than 5 years while pharmacist responders had more years of experience (P
